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Side Effects of Drugs
LETTER S
TO
THE
EDITOR
FOODINENVORV ' List b elo w all fo o d s ea ten y este rd ay . T his sh ou ld include butter, jelly, a n y liquor, su g a r in c o tie ® , an d all sn ac k s.
PROT C a + +
A.A.
G.
0. FOR O FF IC E U SE F resh Fruit
MORNING
M eat C h eese S e a Food Liver Diet. R estr. W eight
SN A C K
M edication NOON
Vitamins
C igarettes A lcohol C o ffee S w e e ts
SN A C K EVENIN G
R em ark s:
SN A CK
Dietary intake is recorded by the patient for thé initial examination. Column headings are Prot, protein; Ca++, cal cium; AA, ascorbic acid; G, good (bananas, potatoes); B, bad (alcohol, refined carbohydrates).
counseling. I think that this method of initial evaluation is more objective than the “risk patients” as determined by Dr. Katz. These comments are not meant as criticism—just perhaps as a suggestion for modification (or im provement) of Dr. Katz’s initial evalua tion. Again, good luck to Dr. Katz in his progressive program.
would certainly indicate that this is a possibility. It is true that some of our patients have problems that are psychogenic, but the percentage of patients in this category is small. I am afraid that we use this excuse to rid ourselves of many patients whose problems we are unable to diagnose.
ANATOL T. CHARI, DDS NEWPORT BEACH, CALIF
ALLEN D. BINNS, DDS COLUMBUS, GA
Emotional disorders?
Side effects of drugs
□ It is easy for us as dentists to blame a diagnostic problem on the patient’s psychological makeup. However, the answer is often beyond our diagnostic ability. This might mean that the diag nosis is available, but we are not famil iar with it. Or, it could mean that, to date, a satisfactory diagnosis is not available to us. Such is the problem with case 2 in the article, “The psycho logical aspects of dental therapy: a diagnostic problem” (May 1981). I think it is unfair to the patient to blame her problem on an emotional disorder, or to say that it is of psychogenic ori gin. The brief dental history that we have in the article is in fact very il luminating. With this limited knowl edge, I think that we could safely say that this woman has some form of tem poromandibular joint disorder. Being able to relate her problem directly to the removal of her posterior teeth
□ The article by Dr. Gobetti, “The psychological aspects of dental ther apy: a diagnostic problem ,” (May 1981) illustrated several interesting features. However, two important points should be added to the case de scription of the 50-year-old woman who had periodic dry mouth. According to the history, she was taking numerous medications, at least three of which (Fluphenazine HCL, Nortriptyline, and Trimipramine) are shown in the Physicians’ Desk Re feren ce1 and The Pharm acological Basis of Therapeutics2 as able to cause xerostomia. In addition, where a pa tien t’s drug history yields such a strong suspicion of inappropriate or inconsistent use of her medications, the drug regimen should be promptly investigated by bringing this suspi cion to the attention of the prescribing physician. Such a review is needed for
158 ■ IADA, Vol. 103, August 1981
the patient’s medical benefit and may result in correction of the xerostomia as well. Referral to a psychiatrist for a prob lem of xerostomia, without first ruling out the known side effects of drugs being used, would generally be inap propriate. In the case described in which the patient appeared to have normal salivary flow but admitted to “ being lonely and feeling isolated from people. . . , ” a psychiatric re ferral may have been indicated. It is hoped that the psychiatrist hastened to correct the inappropriate drug usage; this by itself could lead to improve ment in the patient’s perception of dry mouth (whether real or imagined). Two points should be made. The first is that many commonly used drugs cause intermittent or constant xerostomia. The second is that patients often use overlapping drugs in inap propriate dosages without the knowl edge of their physician. A reference such as the Physicians’ Desk Reference should be available to investigate pos sible drug-related problems as well as to check on the various facets of drugs that the dentist prescribes. WILLIAM B. GILLETTE, DDS INDIANAPOLIS 1. Physicians’ desk reference, ed 35. Oradell, NJ, Medical Economics Co., 1981. 2. Goodman and Gilman’s the pharmacologi cal basis of therapeutics, ed 6. New York, Macmil lan, 1980.
Author’s comment: Dr. Binns’s point is important, and the article stressed the same theme. The dentist must rule out every possibility of organic disease be fore a psychogenic diagnosis can be es tablished. He has missed the impor tance of case 2. Every possible medical and dental evaluation had been done before the diagnosis of psychogenic origin. Dr. Binns’s letter emphasizes the dental history and the removal of the posterior teeth and assumes a tem poromandibular joint (TMJ) disorder; but the patient’s signs and symptoms were not of TMJ dysfunction, but “ dry mouth and burning sensations con fined to the region of the upper lip and tongue.” Therefore, the chief problem, current illness, and medical history do not support the theory of a TMJ disor der. Also, the patient made significant improvement with psychiatric ther apy. Dr. Binns’s letter demonstrates the point I was attempting to make while
TO
THE
EDITOR
FOODINENVORV ' List b elo w all fo o d s ea ten y este rd ay . T his sh ou ld include butter, jelly, a n y liquor, su g a r in c o tie ® , an d all sn ac k s.
PROT C a + +
A.A.
G.
0. FOR O FF IC E U SE F resh Fruit
MORNING
M eat C h eese S e a Food Liver Diet. R estr. W eight
SN A C K
M edication NOON
Vitamins
C igarettes A lcohol C o ffee S w e e ts
SN A C K EVENIN G
R em ark s:
SN A CK
Dietary intake is recorded by the patient for thé initial examination. Column headings are Prot, protein; Ca++, cal cium; AA, ascorbic acid; G, good (bananas, potatoes); B, bad (alcohol, refined carbohydrates).
counseling. I think that this method of initial evaluation is more objective than the “risk patients” as determined by Dr. Katz. These comments are not meant as criticism—just perhaps as a suggestion for modification (or im provement) of Dr. Katz’s initial evalua tion. Again, good luck to Dr. Katz in his progressive program.
would certainly indicate that this is a possibility. It is true that some of our patients have problems that are psychogenic, but the percentage of patients in this category is small. I am afraid that we use this excuse to rid ourselves of many patients whose problems we are unable to diagnose.
ANATOL T. CHARI, DDS NEWPORT BEACH, CALIF
ALLEN D. BINNS, DDS COLUMBUS, GA
Emotional disorders?
Side effects of drugs
□ It is easy for us as dentists to blame a diagnostic problem on the patient’s psychological makeup. However, the answer is often beyond our diagnostic ability. This might mean that the diag nosis is available, but we are not famil iar with it. Or, it could mean that, to date, a satisfactory diagnosis is not available to us. Such is the problem with case 2 in the article, “The psycho logical aspects of dental therapy: a diagnostic problem” (May 1981). I think it is unfair to the patient to blame her problem on an emotional disorder, or to say that it is of psychogenic ori gin. The brief dental history that we have in the article is in fact very il luminating. With this limited knowl edge, I think that we could safely say that this woman has some form of tem poromandibular joint disorder. Being able to relate her problem directly to the removal of her posterior teeth
□ The article by Dr. Gobetti, “The psychological aspects of dental ther apy: a diagnostic problem ,” (May 1981) illustrated several interesting features. However, two important points should be added to the case de scription of the 50-year-old woman who had periodic dry mouth. According to the history, she was taking numerous medications, at least three of which (Fluphenazine HCL, Nortriptyline, and Trimipramine) are shown in the Physicians’ Desk Re feren ce1 and The Pharm acological Basis of Therapeutics2 as able to cause xerostomia. In addition, where a pa tien t’s drug history yields such a strong suspicion of inappropriate or inconsistent use of her medications, the drug regimen should be promptly investigated by bringing this suspi cion to the attention of the prescribing physician. Such a review is needed for
158 ■ IADA, Vol. 103, August 1981
the patient’s medical benefit and may result in correction of the xerostomia as well. Referral to a psychiatrist for a prob lem of xerostomia, without first ruling out the known side effects of drugs being used, would generally be inap propriate. In the case described in which the patient appeared to have normal salivary flow but admitted to “ being lonely and feeling isolated from people. . . , ” a psychiatric re ferral may have been indicated. It is hoped that the psychiatrist hastened to correct the inappropriate drug usage; this by itself could lead to improve ment in the patient’s perception of dry mouth (whether real or imagined). Two points should be made. The first is that many commonly used drugs cause intermittent or constant xerostomia. The second is that patients often use overlapping drugs in inap propriate dosages without the knowl edge of their physician. A reference such as the Physicians’ Desk Reference should be available to investigate pos sible drug-related problems as well as to check on the various facets of drugs that the dentist prescribes. WILLIAM B. GILLETTE, DDS INDIANAPOLIS 1. Physicians’ desk reference, ed 35. Oradell, NJ, Medical Economics Co., 1981. 2. Goodman and Gilman’s the pharmacologi cal basis of therapeutics, ed 6. New York, Macmil lan, 1980.
Author’s comment: Dr. Binns’s point is important, and the article stressed the same theme. The dentist must rule out every possibility of organic disease be fore a psychogenic diagnosis can be es tablished. He has missed the impor tance of case 2. Every possible medical and dental evaluation had been done before the diagnosis of psychogenic origin. Dr. Binns’s letter emphasizes the dental history and the removal of the posterior teeth and assumes a tem poromandibular joint (TMJ) disorder; but the patient’s signs and symptoms were not of TMJ dysfunction, but “ dry mouth and burning sensations con fined to the region of the upper lip and tongue.” Therefore, the chief problem, current illness, and medical history do not support the theory of a TMJ disor der. Also, the patient made significant improvement with psychiatric ther apy. Dr. Binns’s letter demonstrates the point I was attempting to make while